Provider Demographics
NPI:1689352882
Name:ACANDA GERMAN, LLENISLEYDI (CBHCM0104465)
Entity Type:Individual
Prefix:
First Name:LLENISLEYDI
Middle Name:
Last Name:ACANDA GERMAN
Suffix:
Gender:F
Credentials:CBHCM0104465
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26290 PARKER AVE APT 3304
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-3861
Mailing Address - Country:US
Mailing Address - Phone:305-928-9795
Mailing Address - Fax:
Practice Address - Street 1:26290 PARKER AVE APT 3304
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-3861
Practice Address - Country:US
Practice Address - Phone:305-928-9795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-07
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0104465171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator